Saturday, April 21, 2012

Preparedness and Urinary Tract Infections

     Urinary tract infections are one of the most commonly seen issues by nurse practitioners, general practice physicians and family practitioners.  Since a percentage of women use an obstetrician/gynecologist for their primary health care, they treat an awful lot of them too. Recurrent, confusing, or complex cases wind up as the purview of the urologist.    Although men can and do develop urinary tract infections, most of the cases seen are in women.  The reasons for this are purely anatomical.  A woman's urethra has a length of about 4 cm. while a male urethra is about 20 cm.   Bacteria have very little distance to travel in women, before contaminating the bladder which under normal circumstances, houses urine which is sterile.  In either sex, a bladder infection can progress into the ureters above, and then on to the kidneys, so most of the time, physicians and nurses call it a UTI or urinary tract infection rather than simply a cystitis or bladder infection.
      The symptoms of urinary tract infection include burning on urination, stinging, and may progress to fever, chills, back pain or pain in the genital region.  When it progresses to pyelonephritis, there will be fever, chills, nausea and often severe vomiting.  It is very important that pyelonephritis be correctly treated because it can progress to sepsis, shock and death very quickly. (It's pyelonephritis which kills so many paraplegics and quadriplegics who are not able to sense the pain of such an infection.)       The urine in UTIs can look normal, or in can be bloody, smoky, or have mucus shreds.

Note that in both men and women, the patient's right kidney is lower than the other. In pyelonephritis, the right kidney is therefore usually infected first.  Kidney pain is often felt just below in our backs just below the scapula.

                  Sometimes normally healthy people get a urinary tract infection for no discernible cause, but certain groups are more prone to them.   The people who are most likely to be afflicted are those who are run down for some reason, have a chronic illness of some kind, are elderly or diabetic, pregnant,  have some type of an anomaly of the urethra,  bladder, ureters, or kidneys,  have chronic diarrhea or have had recent diarrhea.  Drinking lots of water can help flush the urinary tract and may prevent a very early UTI from becoming something more.  Powders, creams, and synthetic underwear can also irritate the urethra, and some people with chronic irritation, move on to an infection.
                   Once the patient has burning on urination sufficient that she is reluctant to to urinate, or have bloody urine,  then there is nothing more you can do at home. You need to see your primary care physician/nurse practitioner who may take a sample of the urine, for a dipstick and a culture.  They will prescribe an antibiotic, and perhaps another drug also for the spasms and discomfort of an active urinary tract infection.  Most urinary tract infections are caused by one organism, E-coli, the bacteria which is a normal colonist in our stool.  However, sometimes other organisms have infected the bladder, and this is why a culture of the urine should ideally be taken in order to be certain about which organism has caused the infection, and been certain that the antibiotic chosen by your physician will indeed eradicate it..  The newest thinking is that they assume this is an uncomplicated E-Coli infection and treat you with an appropriate antibiotic for three days.  Yes, earlier thinking was that 10-14 days would eradicate more infections, but it was found that we were producing more resistant strains of E-coli in your colon, which would wind up as resistant bacteria in your bladder sometime in the future.  If your UTI returns after treatment, then you must return to your physician to get treatment with an antibiotic which will be effective for more resistant strains of E-coli or for other bacteria entirely.  Usually a longer course of antibiotic is required for a resistant case. and we see 7-10 days being prescribed then.  UTIs comprise a lot of the visits to physicians, and over 100,000 hospitalizations per year in the US,  when if untreated, they become pyelonephritis (a kidney infection)  They need to be taken seriously.     I have specifically not mentioned kidney stones in this post, but I do wish you to know that kidney stones would certainly complicate any UTI and certainly would complicate pyelonephritis.

             As people with an interest in preparedness, we don't much like being told that this is something we should not manage alone. We can handle prevention, but with something as crucial as your urinary tract and your kidneys, your safest course is to develop a good working relationship with a physician, who even after a collapse or during a real emergency, can still provide this level of medication. A child with a urinary tract infection must ALWAYS see a physician or  nurse practitioner.  Stocking medication that may never be used may not be wise for us.
            We can however, focus on prevention, and there is much we can do to prevent urinary tract infections.  Some of it is likely known to you, and some of it, isn't discussed very much much.  First of all, both men and women need to get rid of synthetic underwear for daily use.  Cotton underwear is for sale at Wal-Mart and this is the safest for most people.  These should be changed daily.  Women who use panty liners should pay attention if a particular brand stays damp or is irritating to them. Irritation can lead to later infection.  Find a panty liner you like, if you use them, and remain with a brand you know. Don't apply talcum or similar powders between your legs. We know that this practice results in talcum crystals being located in ovaries, so it's a much shorter trip to have them wind up in the urinary tract where they can cause irritation. Dribbling or urine from the urethra, whether the patient is a man or a woman, should necessitate a visit to the doctor.  Women should urinate after intercourse in order to help flush bacteria which inadvertently enters her urethra.     Make water your primary drink with any other drink a treat.  Both tea and coffee can irritate the bladder in some people.  Water helps everything function at its best.  Cranberry juice, the juice and not the cocktail drinks do help to acidify urine and can make the replication of bacteria in the bladder more difficult, but there is a fair amount of sugar in it, and many times, the diabetics you seek to have avoid a UTI ,cannot handle the added sugar.

Cranberry juice cocktails are less likely to acidify urine making the environment for organisms less hospitable in urine.  However, cranberry juice is marketed, and if you look carefully, this can usually be found.

              Recently, an astute reader, asked me  to point out that there is a 100% cranberry juice available also, but the labels need to be read closely to be sure that no other juices are added.

The pure 100% cranberry will have 7 grams of sugar per 8 oz serving, where when other juices are added will have closer to 17 grams of sugar, and the juice cocktail will be even higher.  Our astute reader also adds that the pure cranberry juice flavor takes some getting used to, but that it's worth such adjustments.

 There are cranberry juice capsules which are available OTC **   in the US and Canada, that will help to acidify urine, but they also can interrupt blood clotting, and so your physician needs to approve your use of these.  Children and adults should be taught to wipe after defecation from the back and from front to back.  The goal is to keep stool away from the urethra.   In emergencies, or during water outages, a squirt bottle can be fashioned to facilitate cleaning after defecation for those who can't shower as frequently as they might normally.  Men and boys should be instructed to void standing, and to take great care that their penis not touch the toilet seat or the toilet water, particularly in public bathrooms if they must sit to have a bowel movement.  We are seeing an increase in young male urinary tract infections unrelated to STDs.  Both sexes should avoid holding urine. We should void as reasonably soon as possible when we feel the urge to go.

**  OTC means over-the-counter or available without prescription, if you are reading from another nation.

This is helpful to acidify urine when we experience the irritation we may notice prior to developing an overt infection.  However, if you take any medications or have any chronic medical issues whatsoever, you must run this past your primary physician.  It does interrupt clotting time.

               Adequate plain water intake,  using the bathroom to empty the bladder when we need to, avoiding urine stagnation in the bladder, getting enough sleep, buying cotton underwear, showering or using a peri bottle during emergencies when showering is not possible, wiping correctly, and using great care in public bathrooms will go a long way in terms of avoiding a lot of urinary tract infections. 

Lots of water is our best defense during an uncomplicated urinary tract infection, although patients with nausea often prefer to drink their water without ice.

Please also see our next post on this subject at:


russell1200 said...

O.k. - outside of maybe "incest in the bomb shelter" - a popular subject in post apocalyptic fiction during the early coldwar- I think you may have just cornered the market in uncomfortable prepper subjects to discuss. LOL

JaneofVirginia said...

Thanks Russell ! When I worked fulltime, I am unquestionably the person at the meeting who comments on the "elephant in the room". I am not a big fan of denial, and so I tend to deal with the uncomfortable sometimes, in order to get it out of the way. This said, this is a big problem for a lot of women. Urethritis in women probably can be dealt with by themselves, but overt established infection cannot, and can lead to death. It would be terrible to have all someones supplies and lose them to sepsis from a urinary tract infection ! Thanks for your post. Very best wishes.

kymber said...

i have to agree with Russell!

JaneofVirginia said...

And we are still not finished with "communication about urination" ! Please see the follow up post where I post indications for the use of D-mannose, and acidophilus lactobacillus for female urethritis and early cystitis. I promise we are moving away from the toilet, very soon.

CuteRimi said...

I have had 4 uti and been on 4 medines for it and the medine they give me is not helping i have been sick like this for 2 mouths now and have to go to a kidney and bladder spelist next thrurday because i am so sick and can't get rid of the uti's and they keep coming back. i'm using ADULT DIAPERS always.
Thanks, @Rimi

JaneofVirginia said...

Rimi, I am sorry you are having such difficulties with this. It sounds as if a urologist (a physician who specializes in genito-urinary issues) is certainly the right place to go next. I hope he/she does the testing quickly and confirms the diagnosis, and has you on the right medications and on the meds very soon. Very best wishes.

Unknown said...

If you take regular pills and antibiotic to treat uti, you will get relief soon. You can also take cranberry juice to get relief from UTI.

JaneofVirginia said...

Yes, please read my post which follows this one. Certainly, most patients who develop an isolated urinary tract infection, and who see their physician can be treated in fairly short order using common antibiotics. However, more and more women are developing antibiotic resistant varieties of cystitis (bladder infection), and something called interstitial cystitis. Not every cystitis is easily cured by a full run of physician ordered antibiotics.

Elizabeth J. Neal said...
This comment has been removed by a blog administrator.
Linda said...

I was reluctant to urinate. The pain came on suddenly. I knew I had to empty my bladder each time. So, I just screamed as I pushed and emptied my bladder. I called my urologist who called in an antibiotic. It did not help much, then finally subsided. I was going to bed because of the pain that extended to chills all over, goosebumps on my face, and symptoms of exhaustion. Finally, all seemed better. Then, the intermittent symptom of urethra pain were bearable.

It was about time for my gyno visit. I told him and he asked if I took my premarin. Reluctantly, I admitted that it was haphazard, especially since the three months of pain I endured. He said it could be prolapse of the urethra or needing estrogen, which could be administered as a cream. I got the cream, used it for several days and determined to take my premarin regularly. The cream was NOT helping. When I miss even one premarin tablet, I suffer.

The point? The antibiotics were not needed and did not help. I have been taking premarin for 25+ years and made him promise to give it to me in the nursing home. I am also a witch without

As result of occasional UTIs over the years and one that almost killed me 48 years ago, I am careful. I read that keeping absolutely clean, including removing sweatiness by washing often and removing pads or panties that hold moisture, women can avoid many of the UTIs. As a result, I change panties, sometime 4 or more times a day, and at least using a washcloth with only water, my health is better in this area.

I also avoid sitting on cold surfaces in cold weather since I read that can affect the developing of a UTI.

Linda said...

I forgot to say that the piercing pain extended to clitoris, lips and just engulfed me when this was happening EACH time I urinated. People in public bathrooms inquired at to my well-being. I could not suppress the sounds that came from me. LOL I was almost sobbing after the initial stab and spreading of pain.

I did not have prolapsed urethra.

Linda said...

Oh, I just read the comments. I, too, am willing to discuss the uncomfortable subjects. My children were never kept from any subjects on sex because I would inform them of things that embarrassed them long beyond our initial talks about sex and the mechanics and repercussions.

I always answered every question with information they were old enough to understand, even if most seven-year-olds did not know. My friends were horrified my children knew things because they were afraid my children would share.

My four-year-old found her vagina and wanted to know what that 'hole' was. Where you poop. No, that is not it. Where you pee. No, the hole between those. That is where that a baby will come out when you are a grown woman.

"Oh," and she got up like I had said nothing unusual and went about her way, never mentioning it until a year later in a casual conversation.

Sexual parts and sexual subjects, along with elimination topics should NOT be so embarrassing when discussed in a clinical way and not a titillating manner. I am sure you agree. It is almost like never showing a doctor what hurts, just pointing to a doll.

JaneofVirginia said...

Yes, usually what you describe does also require an antibiotic, but more and more women especially (the sex with the short little urethras !) are experiencing irritation beyond infection that actually has been helped with the D-Mannose. I think a package of D-Mannose belongs in everyone's emergency home kit.

JaneofVirginia said...

Yes, a basic knowledge of anatomy from childhood with correct names is necessary simply in order to receive good healthcare. I don't think I embarrassed by kids very much, I just always used the correct words for everything as if the part were an elbow !

Ankita said...

Great article. There are so many remedies used to treat UTI but the most effective natural remedy is the dietary supplements for UTI. I tried these supplements and it works well.